ReviewThe British journal of nutrition2013
Nutritional disturbance in acid-base balance and osteoporosis: a hypothesis that disregards the essential homeostatic role of the kidney.
Review in The British journal of nutrition, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Association between dietary acid load and risk of osteoporotic fractures in adults: a systematic review and meta-analysis of observational studies.BMC musculoskeletal disorders · 2025Pooled it
- Dietary Acid Load and Bone Health: A Systematic Review and Meta-Analysis of Observational Studies.Frontiers in nutrition · 2022Pooled it
- Animal versus plant protein and adult bone health: A systematic review and meta-analysis from the National Osteoporosis Foundation.PloS one · 2018Pooled it
- Trial
- Dietary acidity and bone mass in minority children and adolescents: a cross-sectional analysis from the MetA-Bone trial.Archives of osteoporosis · 2025Article
- Association of dietary acid load with inflammatory markers, oxidative stress, and clinical features in patients with knee osteoarthritis.Scientific reports · 2025Article
- The association between bone density of lumbar spines and different daily protein intake in different renal function.Renal failure · 2024Article
- Review
- Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein.Bone reports · 2023Review
- Nutrients and Dietary Patterns Related to Osteoporosis.Nutrients · 2020Review
- Review
- Benefits and safety of dietary protein for bone health-an expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteopororosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Review
- Prediction of Renal Acid Load in Adult Patients on Parenteral Nutrition.Pharmaceutics · 2018Article
- Dietary acid load, trabecular bone integrity, and mineral density in an ageing population: the Rotterdam study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017Article
- Nutrition and osteoporosis prevention for the orthopaedic surgeon: A wholefoods approach.EFORT open reviews · 2017Article
- Article
- Food fortification for bone health in adulthood: a scoping review.European journal of clinical nutrition · 2016Article
- Effects of Dairy Products Consumption on Health: Benefits and Beliefs--A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.Calcified tissue international · 2016Review
- A look behind the scenes: the risk and pathogenesis of primary osteoporosis.Nature reviews. Rheumatology · 2015Review
- Article
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Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The nutritional acid load hypothesis of osteoporosis is reviewed from its historical origin to most recent studies with particular attention to the essential but overlooked role of the kidney in acid-base homeostasis. This hypothesis posits that foods associated with an increased urinary acid excretion are deleterious for the skeleton, leading to osteoporosis and enhanced fragility fracture risk. Conversely, foods generating neutral or alkaline urine would favour bone growth and Ca balance, prevent bone loss and reduce osteoporotic fracture risk. This theory currently influences nutrition research, dietary recommendations and the marketing of alkaline salt products or medications meant to optimise bone health and prevent osteoporosis. It stemmed from classic investigations in patients suffering from chronic kidney diseases (CKD) conducted in the 1960s. Accordingly, in CKD, bone mineral mobilisation would serve as a buffer system to acid accumulation. This interpretation was later questioned on both theoretical and experimental grounds. Notwithstanding this questionable role of bone mineral in systemic acid-base equilibrium, not only in CKD but even more in the absence of renal impairment, it is postulated that, in healthy individuals, foods, particularly those containing animal protein, would induce 'latent' acidosis and result, in the long run, in osteoporosis.Thus, a questionable interpretation of data from patients with CKD and the subsequent extrapolation to healthy subjects converted a hypothesis into nutritional recommendations for the prevention of osteoporosis. In a historical perspective, the present review dissects out speculation from experimental facts and emphasises the essential role of the renal tubule in systemic acid-base and Ca homeostasis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.